Introduction:
Alcohol consumption is one of the global health concerns as it is one of the common forms of substance abuse in the modern world. Heavy or frequent consumption of alcohol can cause both physical and mental problems. It can affect brain function and may require treatment in the latter stages. The dependence on alcohol can develop quickly or over a period of time. There are several reasons for a person to become dependent on alcohol, namely genetic factors, mental issues, trauma episodes (physical or sexual abuse), etc. When a heavy drinker tries to stop alcohol consumption suddenly, it can lead to severe mental and physical issues. There are many behavioral therapies, medications, and support groups; available to help individuals come out of addiction to alcohol.
What Is Alcohol Withdrawal Syndrome?
The sudden withdrawal from alcohol consumption can affect the body of a heavy drinker both physically and mentally. Those symptoms are collectively referred to as alcohol withdrawal syndrome. The severity of these symptoms can vary from mild to life-threatening conditions accompanied by hallucinations and seizures. It is more common in the male population. It mainly occurs due to the over-excitation of the central nervous system.
What Is the Etiology of Alcohol Withdrawal Syndrome?
Most alcoholic beverages have ethanol as their primary component. It depresses the central nervous system (CNS) when ingested by an individual. The exact cause of alcohol withdrawal syndrome is related to the way alcohol affects the brain and central nervous system. Chronic alcohol use can lead to changes in the balance of neurotransmitters, which are chemicals that transmit signals between nerve cells. GABA (gamma-aminobutyric acid) is a neurotransmitter that has a calming effect on the brain. Alcohol enhances the effects of GABA, which contributes to the sedative and relaxing effects of alcohol. When alcohol intake is abruptly reduced, the brain's GABA system becomes relatively unopposed, leading to overactivity and resulting in withdrawal symptoms.
What Are the Main Symptoms of Alcohol Withdrawal Syndrome?
The symptoms of alcohol withdrawal syndrome vary from mild to severe. The severe form of alcohol withdrawal is named delirium tremens. The severity of the symptoms will depend on the patient, the duration of alcohol dependence, and the volume of alcohol ingested. The mild symptoms usually appear after six hours of alcohol cessation.
They include,
-
Insomnia (lack of sleep).
-
Anxiety.
-
Irritability.
-
Mood swings.
-
Fatigue.
-
Nightmares.
-
Inability to think clearly.
-
Loss of appetite.
-
Nausea and vomiting.
-
Rapid heart rate.
-
Sweating.
The moderate symptoms usually occur 12 to 24 hours after alcohol cessation, including hallucinations and alcohol withdrawal seizures. If proper treatment is not given, it can progress to the most severe manifestation of alcohol withdrawal syndrome, delirium tremens. It is characterized by hallucinations, increased heart rate, increased blood pressure, disorientation, agitation, high body temperature, and sweating. This usually begins after 48 to 96 hours of alcohol abstinence. Almost 5 % of the patients who undergo sudden withdrawal suffer from delirium tremens (DT).
The risk factors that can lead to DT include;
-
Age greater than 30.
-
History of seizures associated with alcohol withdrawal.
-
History of alcohol dependence.
-
Presence of any other illness.
How to Diagnose Alcohol Withdrawal Syndrome?
The diagnosis of alcohol withdrawal syndrome can be made by assessing the history and performing a physical examination of the patient.
Doctors will look for symptoms of dehydration, cardiac issues, abnormalities in electrolyte levels, trauma, gastrointestinal bleeding, etc. The symptoms (fever and altered mental status) of these conditions mimic those of alcohol withdrawal syndrome. In such cases, computed tomography and lumbar puncture may be required to confirm the diagnosis.
Lab tests can be done in the case of chronic alcoholics to check the presence of ketoacidosis.
A tool called the Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) has been devised to assess the severity of symptoms associated with alcohol withdrawal. With the help of this tool, the individuals who require treatment can be easily determined.
How to Treat Alcohol Withdrawal Syndrome?
The treatment for alcohol withdrawal syndrome involves assessing the severity of symptoms, alleviating symptoms, and identifying and treating complications associated with it.
Mild Symptoms
Patients with mild symptoms can be treated as outpatients. They may require a calm and positive environment, healthy food, and fluids. They should be under observation, and if there is any worsening of symptoms should be given proper medical care.
Moderate symptoms
If the symptoms are moderate, patients can be given intravenous rehydration, and the electrolyte imbalances should be treated.
Severe Symptoms
Severe cases of alcohol withdrawal, especially those at risk of delirium tremens or seizures, may require inpatient treatment in a hospital or specialized detoxification center. If the symptoms are severe, the patient may require profound treatment. Long-acting Benzodiazepines are very effective in the management of severe symptoms due to alcohol withdrawal. The patients may require intensive care. Propofol is useful in treating delirium tremens.
Toxic Alcohol Ingestion
If there is toxic alcohol ingestion, it requires the assistance of a toxicologist. This condition mainly occurs when the patient depends on other low-quality alcohol sources to get intoxicated. The main component of this type of alcohol includes isopropyl alcohol. It can cause severe dysfunction of the body system. In case of severe addiction, if the patient cannot afford alcohol, there are chances that they may even consume large quantities of cough syrup and mouthwash to get intoxicated. The consumption of methanol can cause organ failure and blindness.
Post-treatment care includes taking Folic, Magnesium, and Thiamine supplements to treat nutritional deficiencies due to alcohol consumption.
Psychosocial Support - Counseling, therapy, and support groups play a crucial role in addressing the psychological aspects of alcohol dependence. These interventions can help individuals develop coping strategies and prevent relapse.
What Are the Complications Associated With Alcohol Withdrawal Syndrome?
The complications associated with alcohol withdrawal syndrome include,
-
Seizures.
-
Anxiety.
-
Depression.
-
Sleep disturbances.
-
Heart problems.
-
Hallucinations.
-
Brain disorders.
-
Delirium tremens.
Conclusion:
The prognosis of alcohol withdrawal depends upon several factors. For most of the patients, the outcomes of treatment are good. If the case has progressed to delirium tremens, then the mortality rate is quite high. However, the death due to DT has drastically reduced from 37 % to 5 %, mainly due to advancements in diagnosis and treatment modalities. The patients should be aware of the fact that treating the alcohol withdrawal syndrome alone cannot guarantee abstinence from alcohol. Enrolling in rehabilitation programs, counseling programs, and taking medications can help get rid of alcohol addiction. Along with proper medical care, support from family and friends is an inevitable factor for an individual to get rid of alcohol addiction.
